Dificultad respiratoria con anemia, trombocitopenia e insuficiencia renal / Respiratory distress with anemia, thrombopenia and renal failure

No disponible

[Brain abscess in children]. / Absceso cerebral infantil.

INTRODUCTION: Brain abscess is a rare infection in infants. Morbidity and mortality are high but have decreased due to advances in neuroimaging studies and the use of new antibiotics. We describe six cases of brain abscess diagnosed at the Gregorio Marañón Children's Hospital between January 1996 and September 2003. METHODS: We performed a retrospective chart review of patients with brain abscess. The variables analyzed were age, sex, clinical symptoms and signs, radiological studies, etiology, therapy, and clinical outcome. RESULTS: Age ranged from 8 to 15 years (mean age: 11 years). There were three girls and three boys. The most frequent symptoms were neurological with associated sinusitis in four patients, congenital cyanogenic cardiopathy in one patient and meningitis in one patient. Diagnosis was established through computed tomography (CT) of the brain in five patients and through magnetic resonance imaging (MRI) in one patient. In five patients the abscess was located in the frontal lobe. All patients received broad-spectrum antibiotics and five underwent surgical drainage. Two patients had neurological sequelae. CONCLUSIONS: Although rare, brain abscess should be considered in patients with neurological manifestations associated with otorhinolaryngological infections or congenital cyanotic cardiopathy. When suspected, a CT or MRI must be performed to rule out this diagnosis and, if confirmed, prompt therapy with broad-spectrum antibiotics should be started. Surgical drainage may be needed.

[Severe hypernatremia: survival without neurologic sequelae]. / Hipernatremia grave: supervivencia sin secuelas neurológicas.

Hypernatremia is an electrolyte disturbance most frequently caused by excess water loss and less frequently by increased sodium intake. The few reported cases of severe hypernatremia (> 190 mEq/l) had an adverse outcome with high mortality and/or severe neurologic sequelae. The first case was a 7-year-old girl with renal failure undergoing continuous venovenous hemodiafiltration therapy who presented hypernatremia (216 mEq/l) after incorrect preparation of dialysis fluid. The patient was treated with hemodiafiltration and hypernatremia was resolved in 48 hours. She had a convulsive crisis without subsequent neurologic impairment. The second patient, a 3-year-old girl with pseudohypoaldosteronism type I and encephalopathy, had hypernatremia (203 mEq/l) due to erroneous sodium administration, which was corrected in 36 hours with intravenous fluid therapy. Her neurologic status was unchanged by treatment. We conclude that children with extreme hypernatremia survive without neurologic sequelae if treatment achieves a progressive decrease of natremia.

Hipernatremia grave: supervivencia sin secuelas neurológicas / Severe hypernatremia: survival without neurologic sequelae

La hipernatremia es una alteración hidroelectrolítica debida principalmente a pérdidas aumentadas de agua o aumento de aporte de sodio. Los pocos casos publicados de hipernatremia grave (> 190 mEq/l) presentan elevada mortalidad y/o secuelas neurológicas importantes. El primer caso es una niña de 7 años con insuficiencia renal aguda en tratamiento con hemodiafiltración venovenosa continua que presentó hipernatremia de 216 mEq/l por preparación incorrecta del líquido de diálisis. Fue tratada con hemodiafiltración que se corrigió en 48 h. Presentó una crisis convulsiva aislada sin alteraciones neurológicas posteriores. La segunda paciente, una niña de 3 años con seudohipoaldosteronismo tipo I y encefalopatía, presentó hipernatremia de 203 mEq/l debida a administración errónea de sodio, que se corrigió en 36 h con fluidoterapia intravenosa. Tras el tratamiento presenta un estado neurológico similar al previo. Concluimos que los niños con hipernatremia grave pueden sobrevivir sin secuelas neurológicas, con un tratamiento que consiga un descenso progresivo de la natremia (AU)